Provider Demographics
NPI:1689609869
Name:BOHDIEWICZ, PAUL J (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:BOHDIEWICZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 NEWBURNE POINTE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-1411
Mailing Address - Country:US
Mailing Address - Phone:248-332-3260
Mailing Address - Fax:248-332-3260
Practice Address - Street 1:543 NEWBURNE POINTE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-1411
Practice Address - Country:US
Practice Address - Phone:248-332-3260
Practice Address - Fax:248-332-3260
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0605192085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4688790Medicaid
MI4688790Medicaid
MIB06018009Medicare ID - Type Unspecified